Healthcare Provider Details

I. General information

NPI: 1669867099
Provider Name (Legal Business Name): JOHN ALLEN COCKERELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOHN A COCKERELL MD

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 RICHARDS RD STE I
NORTH LITTLE ROCK AR
72117-2744
US

IV. Provider business mailing address

4020 RICHARDS RD STE I
NORTH LITTLE ROCK AR
72117-2744
US

V. Phone/Fax

Practice location:
  • Phone: 501-916-9693
  • Fax: 501-916-9804
Mailing address:
  • Phone: 501-917-9693
  • Fax: 501-916-9804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-11342
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: